PICOT: Central Line-Associated Bloodstream Infections

Central Line-Associated Bloodstream Infections
Date
Background
The Central Line-Associated Bloodstream Infections (CLABSI) are one of the hospital-acquired infections or nosocomial infections (HAIs), that are costly and are associated with a long stay in the hospital. According to the Center for Disease Control and Prevention (CDC) (2011), CLABSI accounts for 5% of the re-hospitalization rates and 12-25% of the mortality rates. Even as the CLABSI rates have increased, especially in the surgical units, these infections are mostly preventable when there is better hygiene like proper hand hygiene, prevention bundles as well as patient and staff education.
                                                            Problem statement
Improving nursing practice to reduce the risk of bloodstream infections improves patient outcomes and patient safety.    Even as nurses follow workplace policies, procedures, and prevention bundles, CLABSIs are still a problem, and the bloodstream infections increase healthcare costs while compromising the health of patients. If the interventions are effective in reducing CLABSIs, there are lower risks of complications as the evidence-based interventions are associated with quality improvements (Bundy et al., 2014). Adherence to bundles, implementing better prevention practices and selecting a healthcare team tasked with supervising the central line insertion is implemented to determine the impact on CLABSI rates.
                                                Purpose of the change proposal
Evidence-based practice supports best practices in the CLABSIs prevention strategies to improve quality improvement interventions and patient outcomes. If changes in central line insertion practices result in better patient safety and quality of care, they would be implemented to reduce the CLABSI rates. Additionally, central bundle practices are implemented based on the best evidence available since this will lower the mortality and morbidity associated with CLABSIs.
PICOT
For the patients in the Intensive Care Unit, dedicated staff to supervise the central line insertion compared to either bedside nurses will reduce CLABSI infection rates during the time of hospitalization

• P – Patient/ population, in this study, who is the patient becomes the question. In the situation, it is the in-patient.


• I – Intervention, this study is utilizing a team of dedicated staff to supervise the central line insertion.


• C – Comparison here is to find out if it is either bedside nurses are going to be accountable for the maintenance and care of central line or a team that is dedicated


• O – Outcome, there would be a reduced CLABSI infection rate.


• T – Time here refers to the duration of patient stay in the ICU (Intensive Care Unit).

There has been a rise and an increased focus on the rate of infection control, according to Hoffman and Mueller (2017). Focusing on an increased effort to control and preventive method of infection control remains the entire plan. Maintenance, monitoring, and handling of central line are guided by nursing practice to maintain the standard of care and maintenance of these lines. To reduce the rate of CLABSI, hospitals and other health facilities are to focus on utilizing preventive measures and clinical judgment (Bundy et al., 2014). Evidence-based practices on CLABSI prevention are prioritized to improve health outcomes and prevention CLABSI.
Literature search strategy employed
Keywords were used in Google scholar, the CDC and electronic databases including EBSCOhost, Proquest, PMC and Pubmed to determine the CLABSI prevention strategies. The keywords were Central Line-Associated Bloodstream Infections- (CLABSI) are one of the hospital-acquired infections (HAIs), Intensive Care Unit (ICU), compliance, patient safety, patient outcomes preventive measures and evidence-based nursing. The search was narrowed down to recent articles published between 2013 and 2018.
Evaluation of the literature
Bundy et al.  
The study focused on the impact of standardizing Central lines (CLs) on CLABSI rates in pediatric hematology/oncology inpatients (Bundy et al., 2014). Subsequently implementing the of line care bundles to prevent CLABSI was effective in reducing CLABSI in pediatric patients. The quality improvement collaborative showed reduced CLABSI rates in children across the different member institutions and units, and this consistent with a decrease in infections in hospitals catering to adults and children.
Cho et al. 
The study was conducted in 10 Korean ICUs to evaluate the effectiveness of central line insertion interventions for patients with central-line catheters. The results showed that the compliance with the central line insertion practices bundle was associated with lower risk of CLABSI in the ICUs and hospitals. The results are consistent with the project findings that health teams focused on care bundles and practices improve health outcomes. However, the only limitation is that the study focused on a single center for a short period and this affects generalizability (Cho et al., 2017).
 
 
 
Hoffman & Mueller article 
A multifaceted intervention system is effective to improve patient safety as various interventions are integrated from marinating high hygiene levels, maintenance, bundles and patient education on proper central line dressing changes (Hoffman & Mueller 2017).
Implementation of multiple interventions resulted in CLABSI rate in a three year period. However, the study was conducted in one 250-bed hospital, and this is a limitation as there no comparison on how the interventions affect CLABSI rates.
Sacks et al. 2014
 Improvements in insertion procedures have been in the areas targeted to improve patient safety and health outcomes. Compliance with the central line bundle and insertion procedures or checklist is associated with reduced CLABSI related to insertion (Sacks et al., 2014). There were 1,141 patients in the pre-intervention phase and 535 at the post-intervention phase  
Schwartz et al. 2016
In the study by Schwartz et al., (2016) when there was a higher teamwork climate scores there were better patient outcomes as there was open communication about medical errors, infection rates and ways to improve patient outcomes. The project results are similar to those of the study since the team works climate in ICU settings affected how the health care teams worked together and relied on evidence-based practice to improve patient care and safety.
Taylor et al. Article
 The risk of CLABSI was lower after using the checklist among the 318 infants...